PROCEDURE NAME: Fine Needle Aspirates of
Palpable Masses
EQUIPMENT AND MATERIAL
You will need:
Needles 1 ½ - 3 ½” spinal needles
22-23 gauge routinely
25 gauge for thyroid
18-20 gauge for fibrotic lesions
Syringes 10-20 ml (with Leur Loc if using holder)
Syringe Pistol Holder (optional)
Alcohol or Betadine Swabs
Sterile Gauze Pad
Anesthetic
Spray fixative (if making smears)
This FNA KIT Provides:
A container with Cytolyt Solution
A cytology FNA request/report form
This set of instructions.
Kits are available at CAP-Lab 517-372-5520
PATIENT PREPARATION: Place the patient in a comfortable
position, lying or sitting, that allows the lesion to be palpable and
easily aspirated. Clean overlying skin and anesthetize (optional).
All thyroid aspirates are done in ultrasound.
ASPIRATION:
A.
Clean overlying skin if not already done for anesthesia purpose.
B.
Attach needle and syringe. Fit into optional holder (offers one-
handed withdrawal and release of syringe plunger).
C.
Immobilize the area with the thumb and index finger of one hand.
D.
Insert needle into the mass with a single quick motion without
negative pressure in the syringe. Keep the mass firmly stabilized.
E.
With needle in mass, retract the syringe plunger to create negative
pressure in the syringe. This draws material into the needle. Use
up to 10 cc negative pressure for the breast, but much less for
thyroid due to vascularity.
F.
Move the needle back and forth quickly several times and direct
into different areas of the mass. This fanning allows for sampling in
a wide area of the lesion. Maintain constant negative pressure
throughout.
G.
At the first sight of specimen in the syringe, the aspiration is
complete. It is important not to dilute the cellular material with fluid
or blood. See exception below.
H.
Allow pressure in the syringe to return to normal by gently releasing
the plunger. The aspirated specimen should remain in the needle.
Withdraw the needle from the patient.
I.
Apply direct pressure with the sterile gauze at the needle site.
J.
EXCEPTIONS to “G” above
If a CYST is encountered during the aspiration, evacuate all fluid
from the cyst. Perform a second aspiration on any residual mass
using a new syringe and needle.
If BLOOD is aspirated into the syringe, stop the procedure
immediately and choose another aspiration site. Use a new syringe
and needle for the repeat aspiration.
If PUS is encountered, withdraw as much of the material as
possible and perform a repeat aspiration in an adjacent area.
SPECIMEN HANDLING
A.
Eject the specimen into the labeled container of 30 ml of Cytolyt
Solution. Then rinse the needle well by re-aspirating/ejecting the
fixative.
B.
Additional needle passes from the same site may be combined into
the same fixative container. However, if specimens vary grossly or
a different site is aspirated, a second FNA kit should be used.
INFECTIOUS LESIONS
When an infectious process is included in the differential diagnosis,
a culture of the aspirated material is often desirable. Perform a
separate aspiration and eject the collected material into the
appropriate culture tube (Not included in this kit).
TRANSPORTATION:
A.
Return the completed forms, slide folders and labeled specimen
container to the bag. Fixed specimens can be held up to 2-3 days
for batch delivery, however, this will delay results. Daily delivery is
preferred.
B.
Deliver to CAP-Lab. Delivery late in the afternoon to Lab could
cause a 1 day delay in results. Offices may call CAP-Lab at
517-372-5520 and request a courier pick-up.
C.
Expected turn-around-time will be 1-2 days from delivery.
These instructions are adapted from Feldman and Covell of the
University of Virginia Medical Center.
REFERENCES:
Kini, S., Guides to Clinical Aspirated Biopsy – Thyroid, Igaku-shoin,
New York, 1987.
Feldman, P., and Covell, J., Fine Needle Aspiration Cytology and
its Clinical Aspirations: Breast and Lung, ASCP PRESS, Chicago,
1985.
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